OGCO-C1.7 Rubella in pregnancy

Question 1

What is the typical presentation of maternal rubella infection?
How to make dx?

Answer 1

• About 25-50% are symptomatic
• Symptomatic women may experience fever, malaise, lymphadenopathy and diffuse, fine maculopapular rash that usually starts on the face and generalized within 24 hours and typically lasts 1-3 days
• Rubella is transmited by droplets from nasopharyngeal secretions or direct contact with patients
• Incubation period is around 14-21 days and women are infectious from 7 days before and up to 7 days after the onset of the rash.

Question 2

What is the Mx algorithm for women with possible exposure to rubella virus?

Answer 2

Question 3

If there is maternal rubella infection what must be done?

Answer 3

• Universal and droplet precaution should be adopted when approaching apteitns
• Patients with rubella infection should be isolated from susceptible individuals for 7 days after developing rash
• Rubella is a statutory notifiable disease in HK –> reported to CENO via notifiable disease and outbreak reporting system (NDORS)

Question 4

What is the risks of fetal rubella infection?

Answer 4

• Fetal rubella infection increases the risk of miscarriage, stillbirth and congenital rubella syndrome
• Common congenital abnormalities: congenital cardiac lesions, cataracts, microcephaly, mental deficiency

Question 5

Who gets the rubella vaccination?

Answer 5

• Women of child-bearing age should be vaccinated only if they are shown to be susceptible by serological testing.
• Antenatal management
  o Explain importance of post-partum Rubella vaccination to all non-immune mothers.
  o Not recommended to give rubella vaccination (live attenuated vaccine) during pregnancy
  o However, if vaccination occurs within 3 months prior to or during pregnancy, risk of congenital abnomrality is low.

Post delivery
* Discuss with women the need for rubella vaccination
* Explain need for contraception for 1 month after vaccination and discuss suitable contraceptive methods
* Breastfeeding is not a contraindication to postpartum rubella vaccination